Tracheopexy and aortopexy for circumflex aortic arch on a small infant.

Circumflex aortic arch is a rare vascular ring anomaly, which is often associated with tracheobronchomalacia. Aortic uncrossing is the definitive repair of this condition, which is a major high-risk operation; therefore, it is not suitable for small patients such as newborn infants or individuals who have severe comorbidities. We present a case of the circumflex aortic arch with tracheobronchomalacia in a 2.7-kg infant who underwent successful innovative combined surgery of the airway and the aorta.

Multiple Venous and Pulmonary Artery Thrombosis as the Presenting Features of Spontaneously Reversible Nephrotic Syndrome after Exposure to SARS-CoV-2 Virus (Pfizer/BioNTech BNT162b2) Vaccination.

We report an unusual case of nephrotic syndrome and multiple venous thromboembolism (VTE) four days after BNT162b2 injection. The patient presented with a three-day history of foamy urine and one-day history of right leg swelling. The investigation showed 9.5 g of 24 hr urine protein, hypoalbuminemia (2.6 gm/dL), and hypercholesterolemia (320 mg/dL). The duplex ultrasonography revealed VTE of the right lower extremity veins (common femoral vein, saphenous vein, and popliteal vein). Computed tomography (CT) showed thrombosis of the infrarenal inferior vena cava (IVC) extending to both iliac veins and acute pulmonary embolism. Kidney biopsy was performed. The diagnosis of minimal change disease was made. The patient received anticoagulation without steroid or immunosuppressive medications. The nephrosis was spontaneously resolved in 20 days; thus, it strongly suggested the diagnosis of vaccine-induced minimal change nephropathy. Reports of kidney adverse events and clinical characteristics are further needed in the circumstances of worldwide SARS-CoV-2 vaccine usage.

CT-Based Biomarkers for Prediction of Chronic Thromboembolic Pulmonary Hypertension After an Acute Pulmonary Embolic Event.

OBJECTIVE. The purpose of this study is to assess CT-based markers predictive of the development of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary embolism. MATERIALS AND METHODS. Identified from a search of local registries, 48 patients who had CTEPH develop were included in the study group, and 113 patients who had complete resolution of acute pulmonary embolism were included in the control group. Baseline CT scans obtained at the time of the initial pulmonary embolism event were evaluated for the degree of clot-induced vessel obstruction, the quantitative Walsh score, the ratio of the right ventricle diameter to the left ventricle diameter, the right atrium diameter, the pulmonary artery diameter, right heart thrombus, pericardial effusion, lung infarction, and mosaic attenuation. Classification and regression tree analysis was used to create a decision tree. The decision tree was externally validated on an anonymized cohort of 50 control subjects and 50 patients with CTEPH. RESULTS. During univariable analysis, an increase in the degree occlusive clot on initial imaging, a decrease in the Walsh score, absence of pericardial effusion, presence of lung infarction, and the presence of mosaic attenuation were associated with an increased probability of CTEPH development. In the final decision tree, the occlusive nature of the clot remained. Two patients in the cohort used for external validation had nondiagnostic findings and were excluded. The decision process correctly classified 33% (16/48) of patients who had CTEPH develop and 86% (43/50) of patients who did not have CTEPH develop, for an odds ratio of 3.1 (95% CI, 1.1-8.3). CONCLUSION. The presence of an occlusive clot on initial imaging is associated with an increased probability of CTEPH development. Presence of mosaic attenuation and lung infarction may also predict CTEPH development, although additional studies are needed.

Lead Location as Assessed on Cardiac Computed Tomography and Difficulty of Percutaneous Transvenous Extraction.

OBJECTIVES: This study sought to retrospectively investigate outcomes of lead extraction by using pre-operative computed tomography (CT) scans to identify risk of complicated lead extraction to aid in pre-procedural planning. BACKGROUND: Transvenous lead extractions remain high-risk procedures requiring specialized operators, equipment, and surgical backup. Data are lacking for how to identify difficult lead extractions. CT scans, which can illustrate the proximity of the lead to adherent venous structures can potentially aid in identifying difficult lead extractions. METHODS: All cases of patients who were undergoing transvenous lead extractions at the authors' institution between 2015 and 2018, who had a pre-operative CT scan prior to lead extraction, were reviewed. The images were retrospectively reviewed to examine adherence of leads to the surrounding vein and obtained procedural outcomes. RESULTS: A total of 203 cases were reviewed of patients undergoing transvenous lead extraction who had a pre-operative CT scan, and scans were separated based on lead location in the superior vena cava, as assessed by CT imaging. Scans were divided into 3 groups: those in a central location or <1 cm adherence (n = 28); those that had at least 1 lead with tip adherent >1 cm (n = 137); or those that had at least 1 lead outside the vein contour (n = 38). Although there was only 1 serious complication requiring vascular surgery intervention, patients with at least 1 lead outside the vein contour required significantly longer procedural time (190.8 ± 86.6 min vs. 158.1 ± 73.7 min vs. 142.8 ± 52.2 min; p = 0.019) and fluoroscopy time (33.1 ± 24.2 min vs. 19.6 ± 18.4 min vs. 18.3 ± 16.4 min; p = 0.0006) than those with leads adhering >1 cm and centrally located leads, respectively. CONCLUSIONS: Pre-operative CT scanning can identify difficult lead extractions prior to performing the procedure. This information may aid electrophysiologists in the planning of extraction procedures. Future prospective studies are needed to confirm these findings.

Noninvasive Multimodality Imaging for the Diagnosis of Constrictive Pericarditis.

There is a need to review the multimodality imaging techniques, as well as the emerging role of the newer noninvasive imaging modalities in the field of constrictive pericarditis (CP). Therefore, the aim of this review is to summarize the current available techniques that are useful for the diagnosis and differentiation of CP from restrictive cardiomyopathy. Also, we provide illustrative images and videos of typical CP noninvasive imaging findings, as well as a diagnostic and management algorithm. CP is a challenging diagnosis; therefore, cardiologists need adequate knowledge about the application of multimodality noninvasive imaging in a systematic and guideline-oriented fashion whenever CP is suspected.